Incorporating Health Into the Planning and Design of Transportation Improvements
- 2. Learning Objectives Understand the relationship between public health and transportation planning Health impact assessment Best practices Lessons learned
- 3. What factors determine our health?
- 4. Family health history Source: Healthy Community Design – Making the Healthy Choice the Easy Choice (part of the CDC Healthy Community Design Checklist Toolkit)
- 5. Behaviors/lifestyles Source: Healthy Community Design – Making the Healthy Choice the Easy Choice (part of the CDC Healthy Community Design Checklist Toolkit)
- 7. The growing cost of health care is a global megatrend CDC projects that by 2017, 19% of our GDP ($3 trillion) will be spent on health care One-third of adults and 17% of children in the US are obese Adult obesity rate could reach 43% of the population by 2018 Medical costs associated with obesity is ~$147 billion We could save ~$5.5 billion in health care costs related to obesity if one in 10 adults started a walking program Physical inactivity and unhealthy diet are second only to tobacco use as the main cause of premature death in the US How we design communities reinforces the epidemic of obesity, diabetes, high blood pressure, heart disease, asthma, orthopedic, and psychological disorders
- 8. We have changed how much we walk or bike.
- 9. Source: CDC, 2000 walked or biked to school in 1974 66% of children
- 10. Source: CDC, 2000 walked or biked to school in 2000 13% of children
- 11. Consequences Adult Obesity Rate by State, 1995 1991 Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)
- 12. Consequences Adult Obesity Rate by State, 2000 Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)
- 13. Consequences Adult Obesity Rate by State, 2016 Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)
- 14. Consequences Adults with Diabetes Rate by State, 1995 Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)
- 15. Consequences Adults with Diabetes Rate by State, 2003 Source: Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability – Richard J. Jackson MD MPH AIA(Hon)
- 16. Consequences Adults with Diabetes Rate by State, 2016 Source: http://www.americashealthrankings.org/reports/annual
- 17. The Solution We need to reverse the trend—prevention vs. treatment Public health is no longer solely the business of health professionals Relationship between the built environment and health – Strong connection between transit rich communities and better health outcomes – Health is a competitive advantage for cities and their economic development efforts – Opportunities to be healthy are influencing what people want in their communities, workplaces, schools and public spaces
- 18. “Health is where we live, not a doctor’s office.” —Dr. Richard Jackson, MD, MPH
- 19. What is Healthy Community Design? Health A state of complete physical, mental, and social well-being and not merely the absence of disease Healthy Community Design Planning and designing communities and the built environment in a way that makes it easier for people to live healthy lives
- 21. Benefits of healthy community design Improve air and water quality Lower the risk of traffic-related injuries Easier to include physical activity into everyday life Increase access to healthy food Increase social connectivity and sense of community Ensure social equity for all community members Promote good mental health
- 22. Who is beginning to incorporate HCD in the planning and design process? Transportation Agencies USDOT FHWA FTA State DOT’s (FL, MA, OR) MPO’s “Transportation is an important part of the built environment and significantly influences physical activity and well-being, safety and the ability of community members to access destinations that are essential to a healthy lifestyle.”—USDOT Volpe Transportation Center
- 23. Who is beginning to incorporate HCD in the planning and design process? Federal, State and Local Planning Agencies HUD/USDOT/EPA Sustainable Community Plans Choice Neighborhoods Comprehensive Plans Corridor Studies Complete Streets Redevelopment Plans Zoning/Design Guidelines
- 24. How should Healthy Community Design be applied to transportation projects? Apply the principles of HCD into the transportation planning process—holistic approach that can be used to determine which design solutions work best Establish health indicators (metrics/measures) to assess and evaluate effectiveness Partner with health agencies/organizations
- 26. A Healthy Corridor “Shift the focus from moving cars to connecting people” Barriers Curb cuts Traffic volume and speed Roadway dimensions Lack of sidewalks and bike lanes Lack of access to healthy food Undesirable land uses (fast food, car dealerships/repair shops, liquor stores, gas stations) Multiple landowners Multiple jurisdictions Linear, not nodal Lot size DOT standards—metric for success is moving cars efficiently Not enough density to support mixed-use Lack of political and civic leadership in making corridors healthy places Access to local health data
- 27. A Healthy Corridor Attributes People before cars Sites for community building— local arts and culture, gathering and celebration “Place-focused“— emphasize visual appeal, connectivity, and authenticity Connect to green space and nature Mix of uses Multiple modes of transportation (walking, cycling, automobiles, and transit) Access to healthy and affordable food Connect residents to economic opportunities
- 28. Typical Corridor
- 29. Healthy Corridor Audit | Baseline Indicators Residential Land Use Number of residential units Type of residential housing Condition of residential units Burned, boarded up, or abandoned units Average monthly rent Average home price Residential Demographics Average income % below poverty level Race Obesity percentage Asthma rate Accident rate (crashes, injuries, fatalities)
- 30. Healthy Corridor Audit | Baseline Indicators Non-Residential Land Uses Presence of the following: – Commercial land use – Industrial land use – Religious structures – Civic/Government owned structures – Primary or secondary schools – Anchor institutions – Healthy food retailers – Neighborhood retail – Locally-owned businesses
- 31. Healthy Corridor Audit | Baseline Indicators Public Spaces, Sidewalks and Bike Amenities Undeveloped or Underdeveloped land Number of publicly accessible parks Number of annual programs in public spaces Presence of sidewalks Sidewalk conditions Trails Opportunities for physical fitness Trees shading walking areas Natural environmental features Public lighting Benches Are people being physically active (walking, jogging, biking) Litter Garbage cans Connectedness to adjacent neighborhoods Bike accommodations Bike racks
- 32. Healthy Corridor Audit | Baseline Indicators Transit and Road Characteristics Transit options Number of travel lanes Speed limit Distance between safe pedestrian crossings On street parking Number of curb cuts Traffic control devices
- 34. MassDOT | Arsenal Street Corridor Study RFP Scope: “Analyze public health impacts including data for asthma, myocardial infarction, congestive heart failure, stroke, and hypertension; levels of pediatric and adult obesity; levels of pediatric and adult depression; levels of pediatric and adult diabetes; levels of pediatric asthma; and injuries and fatalities related to vehicle crashes, to the extent these data sources are available.”
- 35. MassDOT | Arsenal Street Corridor Study Data gathering (Town, MAPC and MA Department of Public Health) Health indicators: – Land use: mixed use, residential, commercial, industrial, public spaces, vacant parcels, sites subject to change – Transportation: traffic counts, roadway characteristics, signals, transit, sidewalks and crosswalks, bike accommodations, curb cuts, roadway safety. – Demographic: income, race, employment, tax revenue, home ownership, home values – Environmental: brownfields, noise, air pollution – Public health: obesity, asthma, chronic heart diseases, diabetes, depression – Community assets: schools, day care centers, health care institutions, open space, healthy food establishments, community centers, places of worship, fitness clubs, locally-owned businesses. Health evaluation criteria: – Safe and multi-modal transportation – Community connectivity – Healthy living – Healthy economy – Affordable housing
- 36. Arsenal Street Corridor Study Public Health Assessment | Baseline profile Limited public health data at corridor level Community-wide data indicates that the top three health concerns affecting Watertown include: – Obesity and inactive living – Poor self-management of chronic disease – Mental health issues
- 37. Arsenal Street Corridor Study Public Health Assessment | Baseline profile Obesity and inactive living – Direct connection between obesity/inactive living and stress, mental health, and chronic disease – Having better places to walk promotes more active living and weight loss Key statistics – Watertown (17.6%) has a higher rate of obese students compared to the state average (16.3%) (MassDPH) – Watertown has a high prevalence of obesity and lack of physical activity among adults compared to neighboring communities (Belmont, Cambridge, Waltham) (MassCHIP)
- 38. Arsenal Street Corridor Study Public Health Assessment | Baseline profile Poor self-management of chronic disease – Lack of understanding of how to manage and prevent chronic disease Key statistics – According to Massachusetts Healthy Aging Data Report, Watertown has a number of aging indicators that are worse than the state average % ever had a heart attack % with heart disease % with congestive heart failure % with osteoporosis % with glaucoma % women with breast cancer % men with prostate cancer % with anemia % with benign prostatic hyperplasia Watertown 5.7 46.3 25.2 21.8 25.5 12.1 16.2 54.8 42.8 State 5 44.1 24.8 21.7 25.1 10.3 14.6 48.7 40.9
- 39. Arsenal Street Corridor Study Public Health Assessment | Baseline profile Mental health issues – There is a close link between mental health and physical health Key statistics – Watertown has a higher percentage of people who reported being diagnosed with depression (31.6%) compared to the state (28.6%) (MassCHIP)
- 40. Arsenal Street Corridor Study Public Health Assessment | Public health contributors – Public transit options • MBTA 70 and 70A bus services • MBTA rapid transit and commuter rails accessed via bus services – Access to ped/bike facilities • Sidewalks on both sides • Presence of on/off road and shared bike lanes – Signalized intersections – Mixed use development – Parks/Trails and school play grounds – Street trees
- 41. Arsenal Street Corridor Study Public Health Assessment Public health barriers – Bus service is at/over capacity – Lack of bus stop amenities – Insufficient pedestrian safety features (signal, ADA compliance, sidewalk accommodations) – High crash locations – Congestions and delays – Excessive curb cuts – High automobile traffic volume and noise levels – Lack of public-health conducive land uses (vacant land, automobile service establishments, large format retail)
- 42. Arsenal Street Corridor | Public Health Contributors
- 43. Arsenal Street Corridor | Public Health Barriers
- 99. What determines health? Healthcare Genetics Social, Environmental, Behavioral Factors 20% 60%20% Based on: Slide from The American Healthcare Paradox, Lauren Taylor; Original Source: McGinnis et al, 2002
- 101. OUR NEIGHBORHOODS SHOULD NOT BE HAZARDOUS TO OUR HEALTH.
- 102. Why do we do this work as planners? Counseling & Education Clinical Interventions Long-Lasting Protective Interventions Changing the Context to make individuals’ default decisions healthy Socioeconomic Factors Smallest Impact Largest Impact “Eat healthy, be physically active” Rx for high blood pressure, high cholesterol, diabetes Vaccinations, cessation treatments (e.g. for smoking) Fluoridation, tobacco tax, smoke-free laws Income, Race, Education Complete streets, speed limits, walkability, access to green space Housing, Zoning, Economic Development Examples from Other Sectors Traditional Public Health CDC Health Impact Pyramid
- 103. Slower vehicle speeds make people feel safe and encourage them to be active and walk and bike more. For example, we know that is you are hit by a car going 25 mph, you have a less that a 1 in 10 chance of being killed; at 40mph, you have a nearly 7 in 10 chance of being killed. It’s not right that residents of certain neighborhoods have to experience speeding vehicles and be at greater risk for severe injury and death while others do not. To change this, the officials, planners and public health professionals should use community strategies like traffic calming and slower speed limits to reduce speeding.* * Adapted from Talking about Health in All Policies, Dorfman & Krasnow, Berkeley Media Studies Group
- 104. Speed Limit HIA
- 105. Speed Limit HIA
- 106. • Adopt slow zone policy or enact local legislation Policy Change • Reducing design speeds used as part of local engineering guidance and regulations Systems Change • Traffic calming measures like speed humps, neighborhood traffic circles, and chicanes Environmental Change Sources: Adapted from The National Association of County and City Health Officials definition of PSE Changes Targets of Change
- 107. * Adapted from Talking about Health in All Policies, Dorfman & Krasnow, Berkeley Media Studies Group Housing insecurity results from individuals and families can no longer afford to live in stable and safe housing. Sadly, housing insecurity is issue in our community and having real effects. For instance, children who experience housing insecurity have been associated with poor health, lower weight, and developmental risk. We can’t address the housing insecurity problem working in isolation. We need to work with partner in housing and community development to incorporate health criteria into our housing priorities. Working together, we can address the issue of housing insecurity and fix multiple problems at the same time. It will create more stability in people’s lives, improve childhood outcomes, and strengthen our economy.*
- 110. Healthy Neighborhood Fund HIA
- 111. • Adopt inclusionary zoning policy • Develop HPP with health element Policy Change • Use Managing Neighborhood Change Approach (Anti- Displacement Strategies Toolkit) Systems Change • Use or leverage resources to increase affordable housing choices Environmental Change Sources: Adapted from The National Association of County and City Health Officials definition of PSE Changes Targets of Change
- 112. People are healthier when they have a say in how in their neighborhoods are maintained and how they change. We need to engage residents, especially those who do not typically participate in neighborhood activities, so that we can make improvements like fixing sidewalks and parks so that everyone feels as part of the neighborhood. To do that, the officials, planners and public health professionals should work with residents to support mutual goals that create inclusive and resilient neighborhoods.* * Adapted from Talking about Health in All Policies, Dorfman & Krasnow, Berkeley Media Studies Group
- 113. Photovoice • Record and reflect on community strengths and concerns • Promote critical dialogue and knowledge about important issues through group discussion of photographs • Reach decision-makers
- 114. Placemaking Allows people to create places and streets which are healthy, safe, active, and useful. Photo Credit: Principle+ Incremental, small-scale improvements Local ideas for local planning challenges Short-term commitment and realistic expectations Low-risk, with a possibly of high reward Tactical Urbanism by The Street Plans Collaborative
- 116. • Develop community/public engagement guidance (promote adult education approach) Policy Change • Support training of municipal staff and residents in photovoice Systems Change • Use available materials to make short-term changes and test ideas Environmental Change Sources: Adapted from The National Association of County and City Health Officials definition of PSE Changes Targets of Change
- 118. HEALTH STARTS LONG BEFORE ILLNESS, IN OUR HOMES, SCHOOLS, AND JOBS
- 121. Council of Governments: Chief Elected Officials of each town serve on MetroCOG’s Board of Directors Federally Designated Transportation Planning Organization (MPO) Provide a range of services to the six member municipalities Stratford Fairfield Easton Trumbull Bridgeport Monroe
- 122. About 316,000 people live in the MetroCOG Region 145 square miles in area Located between New York & Boston Bordered by Long Island Sound
- 123. About 316,000 people live in the MetroCOG Region 145 square miles in area Located between New York & Boston Bordered by Long Island Sound
- 124. Healthy Community Design: Greater Bridgeport Obesity and access to physical activity and healthy food were concerns identified by focus group participants and interviewees. Walkability of communities, nutritious school lunches, and accessible and affordable recreational areas were all issues identified as important for changing the environmental landscape to support obesity prevention. Healthy Eating, Physical Activity, and Overweight/Obesity. Greater Bridgeport region focus group participants and interviewees reported that obesity is emerging as a serious community issue, and with it, rising cases of chronic diseases. Survey data indicate that 57% of adults in the region are either overweight or obese. In addition to time constraints, the infrastructure itself – having the healthy choice be the easy choice – was discussed among many assessment participants. Recreational Facilities. According to focus group participants and interviewees, the region has a geography and infrastructure that supports health, although accessibility is an issue for some. Safety concerns constrain physical activity in Bridgeport which has a large number of parks. Participants identified lack of time as another barrier to physical activity. Source: Greater Bridgeport, CT Community Health Assessment. April 2013.
- 125. 71% of Bridgeport residents reported themselves as obese or overweight, greater than state (59%) or national (63%) averages 36% of Bridgeport residents reported themselves as obese greater than state (21%) or national (27%) averages 81% of Bridgeport residents reported that they participated in physical activity on a regular basis East End: 33% of residents reported that they were obese. East Side: 40% of residents reported that they were obese. Source: City of Bridgeport, 2011. Bridgeport Community Allied to REACH Health Equity (Bridgeport CARES): Results of a Community Health Assessment.
- 126. Improving Community Health Goal: Reduce and prevent obesity by creating environments that promote healthy eating and active living in the Greater Bridgeport Region Objective: By 2016, increase by 2% the number of adults engaged in moderate physical activity for at least 30 minutes a day for 5 days a week Strategy: Increase/enhance access to and the number of places to get physical activity in the region Indicators: – Number of adults engaged in moderate physical activity for at least 30 minutes a day for 5 days a week – Number of new locations to get safe access to physical activity created Source: Greater Bridgeport Region Community Health Improvement Plan (CHIP) Report, June, 2013.
- 127. Barnum Station Study: Project Objectives Increase the availability of housing options in a transit-supportive location Improve transit and promote transit- oriented development (TOD) in East Bridgeport Improve access to jobs, education, and services Decrease per-capita vehicle-miles- travelled (VMT) and transportation- related emissions for the corridor Increase participation and decision- making in developing a long-range vision for the area around Barnum Station
- 128. Street Level Station Design
- 129. Station Area Infrastructure Improvements Land use patterns present a challenge to integrating bicycle & pedestrian infrastructure Most principal roads have sidewalks, but many need repairs No designated bicycle facilities or infrastructure A linear park along the Yellow Mill Channel would provide a facility for active transportation, and complement future projects
- 130. East Bridgeport Development Corridor Compact development within walking distance of Barnum Station Mixed-use and market-driven development on appropriate sites Apply complete street principles to the road network Integrate open space within the pedestrian circulation network Improve public transit access and service. Create a Yellow Mill Greenway including multi-use paths Preserve neighborhood scale and character Economic strategy integrated with TOD planning Source: Stantec
- 131. Stakleholder Feedback Need for improved pedestrian routes and safe routes to schools Increased retail and local service shops Expansion and enhancement of park space along the Yellow Mill Channel and Creek
- 132. Source: Stantec
- 133. Source: Stantec
- 134. Active Transportation Improve intersections with amenities and pedestrian facilities by emphasizing complete streets and a balanced approach to pedestrian, transit and vehicular travel Construct the Yellow Mill Greenway to connect the Lake Success Eco-Business to Bridgeport Harbor Bicycle lanes and pedestrian paths along both sides of the Yellow Mill Channel and Creek Complete street strategies include bicycle and pedestrian facilities, improved sidewalks, streetscapes and traffic calming measures Provide a new pedestrian walk from Ogden Street across Yellow Mill Creek via a new pedestrian bridge Source: Stantec
- 135. Source: Greater Bridgeport, CT Community Health Assessment. April 2013. Healthy Community Design & Public Health: Stratford 63% of Stratford residents reported themselves as obese (27%) or overweight (35%) 23% of Stratford residents reported no leisure time physical activity in the past month “It’s a difficult town to be a pedestrian in.” “The way the cars go whizzing by you, it’s unsafe. There really should be a sidewalk there.” “I have lived in other areas where I waved to my neighbors and that’s it. But here, the neighbors really care.”
- 136. Stratford Center Revitalization Plan Mixed-use and pedestrian-oriented development with a range of housing options in proximity to Stratford’s Rail Station Generational diversity and less reliance on personal vehicle use Encourage walking, bicycling, and transit use by locating multiple destinations and trip purposes within a quarter- and half- mile of each other Facilitate the adaptive re-use of existing buildings and infill development Ensure that new development is consistent with and enhances the nearby streetscape and the community’s historic character Zoning Regulations that allow desired development within the TOD Overlay District Source: Stantec
- 137. TOD Ordinance Sidewalks constructed along the frontage of all public streets Main entrances connected by a continuous network of sidewalks Designated crosswalks and pedestrian‐oriented paving treatment at internal and external intersections Street trees, pedestrian amenities and adequate lighting Source: Stantec
- 138. “Superblocks”—very large blocks of over 1000 feet with no internal paths or streets accessible for public use Obstructs pedestrian and bicyclist circulation Source: Stantec
- 139. Source: Stantec
- 140. ¾ mile off-road trail from the train station to a local park ¼ mile connection from a residential neighborhood to the high school & Stratford Center Train station to the commercial district Train station to a residential neighborhood Source: Stantec
- 141. Complete Streets Planning for Stratford Center Safety and access for all ages, abilities, and modes Better connections between residential and commercial areas Improve access to and between public transit systems Develop safe routes to school Design interventions that create a sense of place, reflect the character of Stratford’s different neighborhoods, and evoke a sense of safety and vibrancy Soften existing barriers (e.g., I-95 and rail corridor) Embrace Stratford’s cultural arts, history and natural resources Integrate traffic calming measures to slow traffic and encourage active transportation in key areas
- 143. “It’s a difficult town to be a pedestrian in.” “The way the cars go whizzing by you, it’s unsafe. There really should be a sidewalk there.”
- 144. Lessons Learned
- 145. Lessons Learned Pedestrian and bicyclist safety is paramount—typically no debate about improvements to pedestrian and bicyclist facilities Understand the transportation infrastructure: inventory the availability and condition of sidewalks, crossings and amenities. Safe connections for pedestrians and cyclists to destinations (transit, parks, shopping, jobs) will make physical activity a part of life, rather than a leisure activity.
- 146. Lessons learned Direct relationship between public health and the built environment Include health professionals in the planning process An interdisciplinary team (planners, designers, engineers, developers and health care professionals) bring varied expertise, collaboration and curiosity What seems simple to one discipline is ground breaking for another Health can be a catalyst for capacity building Establish health indicators and be specific about health outcomes Warning: Finding health data is difficult—be clear on the limitations